9 things a fertility expert wants you to know

Fertility can be the big elephant in the bedroom. Whether it's the decision to have children or not, whether you are trying to get pregnant, or whether you want a family in the future but don't feel ready right now, it is something every woman is affected by in different ways.

And for those wanting to start a family, it isn't always straightforward. Around one in seven couples may have difficulty conceiving, which means around 3.5 million people are affected by infertility in the UK.

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Women are also increasingly postponing motherhood until their late 30s and early 40s. This steady shift has been driven by women wishing to establish themselves in their careers, ensure they are financially stable and be in a committed relationship before they start thinking about having children. But the decision to postpone motherhood can leave many feeling as though they're in a race against the biological clock.

With all this in mind, we spoke to Janine Elson, a gynaecologist and specialist in reproductive medicine and surgery, to find out what she really wants women to know about their fertility.

1. Female fertility declines rapidly after the age of 35

Janine explains that the 'biggest thing' she wants women to know is 'that fertility declines with age.' She says: 'I still just see countless women for whom it’s come as a shock in their late 30s, early 40s that their fertility might have declined. From the age of 35 onwards, then that’s when fertility could be seriously affected.'

Around a third of women aged 35 to 40 have fertility problems. This rises to two-thirds when the woman is over 40. This is because the quality of the eggs you produce declines, which is why some women are choosing to freeze their eggs to give them more options if they do choose to delay motherhood.

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2. Illnesses and conditions can affect fertility

Janine says: 'If your mum, or your sisters, or your aunties went through an early menopause, you need to start thinking about your fertility earlier.'

She adds: 'If you've had any chemo or radiotherapy as a child, then that might affect your fertility. If you have a medical conditions, such as diabetes or epilepsy, you might also want to start thinking about fertility earlier on because you might need to monitor what drugs you're taking and control your condition.'

She also recommends speaking to your doctor if you have always had irregular, painful or heavy periods, as it could be a sign of an underlying gynecological problem such as polycystic ovary syndrome (PCOS), a condition that affects around 1 in 10 women of childbearing age and interferes with the growth and release of eggs from the ovaries.

It could also be a symptom of endometriosis. Endometriosis is a common condition where tissue that normally lines the womb grows outside it, meaning the body can't shed the tissue in the normal way. It is estimated to affect approximately 2 million women in the UK and, as well as causing painful and heavy periods, it can lead to problems conceiving, or infertility. It can also be difficult to diagnose as the symptoms vary considerably, so it's important to consult your GP if you do experience any pelvic pain and cramping so they can investigate the causes.

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3. The healthier your lifestyle, the better

'Ideally you want to be living as healthy a lifestyle as possible if you are thinking about children in the future,' Janine says. She says maintaining a healthy weight through a good diet and exercise is key because if you put on a lot of weight when you're younger, it's harder to lose it later on. She also recommends not starting smoking or stopping smoking as early as possible.

'Maintaining a healthy lifestyle is going to help you, whichever way we get you pregnant in the end,' she says.

4. If you're freezing your eggs, it's important to get the timing right

Last year, the Human Fertilisation and Embryology Authority (HFEA) reported for the first time on egg freezing statistics. 'Since 2005, the number of women storing their eggs has increased substantially,' the report found, although they did add that the overall numbers are still fairly small. 'Despite growth of 25% to 30% year-on-year, egg storage cycles are still a relatively small proportion of fertility treatment performed in the UK,' the report clarified.

Egg freezing, via their EggSafe package, is one of a number of options offered by the CARE Fertility group to help preserve your fertility, along with sperm freezing and embryo freezing. If you know you want to start, or grow, your family in the future, or if you have a medical condition or illness that may affect fertility, it is a way to keep your options open.

But Janine says it's important to remember that timing is key. It is best to freeze your eggs before you are 35 because of the reduction in egg quality after that age, but you also want to avoid freezing them too early.

'You need to be aware that they can only be frozen for 10 years, so if you freeze early or in your mid-20s, you need to have used them by your early 30s and actually that probably is a bit too early for most women,' she says. 'The ideal time really to freeze your eggs, thinking about that as a back-up plan, is late 20s, early 30s.'

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5. You should have a fertility assessment after 6-12 months of trying to conceive naturally

'If you’re trying for a family in your mid-30s, we’d normally say try for six months to a year and at that stage if things haven’t happened then it’s worth getting your fertility assessed,' says Janine. If you're younger than 35, you should think about getting some fertility tests done after a year.

'A fertility assessment would involve looking at the couple's general lifestyle, checking things like height and weight, lifestyle advice in terms of healthy eating, a scan to look at the womb, the ovaries and something called the ovarian reserve, where we look at the potential number of eggs there might be available if you need treatment.'

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The assessment will help you decide on the next steps.

6. There are lots of fertility options available to you

'There are lots of options open to you to have a family', says Janine, whether you are a couple unable to conceive naturally, a same-sex couple or a single woman. 'It never really should be that anybody can’t have a family because we have that many options available, whether that be embryo screening, IVF, intrauterine insemination, treatment with donor sperm, donor egg treatment, or adoption.'

7. You should take advantage of all the support offered

Whichever fertility treatment route you decide to go down, Janine recommends you 'use the support that’s available, whether that be friends, family, counsellors, nurses.' At CARE Fertility, they offer a private helpline manned by staff, 1-2-1s for new patients, monthly support events like Walk-N-Talk and a buddy system. Janine suggests it's important to use the support that works for you and 'to try and minimise the pressure that you put on yourself, using whatever will help you to relax – relaxation therapies, yoga – whatever works.'

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8. It's important to acknowledge that it's also okay not to want children

'You see some people who come [for fertility advice] because friends and family and society pressure them in their late 30s to want to have a child, but sometimes when you explore it, they might realise that it isn’t something for them,' Janine says.

9. Genetics will play a big part in fertility treatment of the future

'The use of genetics is increasing. So options coming on board now are things like carrier screening to check that you and your partner are compatible and aren’t at risk of passing genetic conditions to your children,' explains Janine. 'Checking the genetic health of your embryos before we put them back in again is a very big area of future development.'

CARE Fertility already offers preimplantation genetic screening (PGS) for anyone looking to boost their chances of success with IVF treatment. The screening helps to identify embryos that have the right chromosomes for transfer. Research suggests that more than 50% of human eggs have chromosomal problems and that this increases with age, so it’s thought to be the main reason older women can struggle to conceive. If a woman has had treatment before that hasn’t worked, if she has suffered miscarriages, or is in her mid-30s or older, PGS may improve IVF success rates.

Another area where they are using genetics is with non-invasive prenatal tests that can check your pregnancy for chromosome abnormalities. By taking a sample of maternal blood, they are able to check for chromosome abnormalities - which could be a sign of Down's syndrome - as early as 10 weeks, without any risk of miscarriage.

'The emphasis is on having, not just children, but healthy children,' Janine explains.

If you want support and advice on starting a family, you can find more information on the CARE Fertility website.

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